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    Acute Impact of Spinal Manipulation on Pain and Muscle Mechanical Properties in Chronic Low Back Pain: An Assessor Blinded, Randomized Controlled Trial
    (Galenos Publ House, 2025) Araci, Ayca; Kurt, Emine Eda; Tas, Serkan
    Objective: Chronic low back pain (CLBP) represents one of the most challenging and costly musculoskeletal conditions to manage. A variety of therapeutic approaches, including exercise training, pain management strategies, and spinal manipulation and mobilization, are employed in its treatment. Among these, clinical spinal manipulation and mobilization techniques are widely regarded as one of the most effective interventions for reducing pain and disability, offering both short-and long-term benefits. High-velocity spinal manipulation is commonly adopted for treating CLBP and has been associated with changes in muscle activity, but the evidence is controversial. The aim of this study was to analyze the immediate effects of two manual spinal techniques (MST) on pain, flexibility, and muscle mechanical properties in CLBP. Materials and Methods: This single-blinded, randomized comparative trial used a pre-and post-test design. Participants were randomly assigned to two groups: Group 1 received Maitland's posterior-anterior central vertebral pressure mobilization technique, and group 2 underwent the lumbar roll technique. Assessments were conducted at baseline and immediately after the interventions. Muscle mechanical properties were measured using MyotonPro, pain intensity was evaluated using a visual analog scale (VAS), and flexibility was assessed through the sit and reach test and the modified Schober test. Results: Following the interventions, significant improvements were observed in VAS scores and sit-and-reach test results in both groups. Analysis of Schober test data revealed a significant improvement in group 2 (p<0.001). Mechanical properties of the paravertebral muscles at the L3-L4 vertebral level were assessed using MyotonPro, showing statistically significant enhancements in elasticity (Hz) and dynamic stiffness (N/m) in both groups post-intervention. However, no statistically significant differences were identified between the groups. Conclusion: Both MSTs demonstrated efficacy in alleviating pain, reducing muscle stiffness, and enhancing flexibility. In this study, manipulations were applied to the symptomatic side, which yielded positive outcomes in pain reduction and muscle properties. However, further research is needed to determine whether the symptomatic side is superior in terms of therapeutic efficacy.
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    An investigation of the changes in mechanical properties of the orofacial and neck muscles between patients with myogenous and mixed temporomandibular disorders
    (Taylor & Francis Ltd, 2024) Tas, Serkan; Kaynak, Besime Ahu; Salkin, Yasemin; Karakoc, Zehra Betul; Dag, Figen
    Objective: To investigate the possible changes in the mechanical properties of the orofacial and neck muscles in patients with temporomandibular disorders (TMD). Methods: The study included a total of 98 females. Females were divided into three groups as myogenous TMD, mixed TMD, and healthy controls. The frequency (indicator of muscle tone), stiffness, and decrement (related to muscle elasticity) values of the sternocleidomastoid, upper trapezius, cervical extensor, and masseter muscles were measured using a portable myotonometer. Results: The frequency, stiffness, and decrement values of the masseter muscle were higher in the mixed and myogenous TMD groups than those of the control group (p < 0.017). The mixed TMD group had higher frequency and stiffness values in the upper trapezius muscle compared with the control group (p < 0.017). Discussion: The results suggest that the mechanical properties of the oral and neck muscles may be affected in patients with TMD.
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    Fatty infiltration and morphology of cervical muscles in patients with temporomandibular disorders: A case-control study
    (Wroclaw Medical Univ, 2024) Kaynak, Besime Ahu; Tas, Serkan; Tufek, Muhammed Taha; Dag, Figen; Dikici, Rumeysa
    Background. Changes in the fatty infiltration and/or muscle volume of neck muscles can alter cervical spine alignment and cranial load distribution, which may cause pain in the orofacial region. Objectives. The aim of the study was to examine the muscle volume and fatty infiltration of neck muscles in patients with temporomandibular disorders (TMD). Material and methods. This case-control study included 18 patients with TMD and 18 age- and sex-matched controls. The muscle volume and fatty infiltration of the neck muscles of the participants were measured using magnetic resonance imaging (MRI) and ITK-SNAP software. The 3D models of the sternocleidomastoid (SCM), splenius capitis (SPLC), semispinalis cervicis (SC)-semispinalis capitis (SCP), and multifidus (M) muscles within the C3-C7 range were created using ITK-SNAP, a semi-automatic segmentation software. The models were used to determine the volumes and fatty infiltration levels. The Neck Disability Index (NDI) was used to assess neck pain-related disability. The severity of TMD was determined using the Fonseca Anamnestic Index (FAI), while jaw-related disability was measured with the Jaw Functional Limitation Scale-20 (JFLS-20). Pain levels were recorded at rest and during chewing using the numeric rating scale (NRS). Results. There were no statistically significant differences in total muscle volume, fatty infiltration volume and fatty infiltration percentage of the SCM, SPLC, SCP, SC, and M muscles between the 2 groups (p > 0.05). The patient group had higher NDI scores compared to the controls (p < 0.001). The NDI scores correlated positively with the JFLS-20 (r = 0.831, p < 0.001), FAI (r = 0.815, p < 0.001) and NRS scores at rest (r = 0.753, p < 0.001) and during chewing (r = 0.686, p < 0.001). Conclusions. The present study did not identify any significant differences in the neck muscle volume or fatty infiltration between the TMD patients and controls. However, the severity of neck disability was found to correlate with jaw function, pain and TMD levels.
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    Immediate Effect of Cumulative Transverse Strain via Exercise on the Achilles Tendon in Individuals with and Without Flat Feet
    (Amer Podiatric Med Assoc, 2025) Tas, Serkan; Kocyigit, Murat Fatih; Araci, Ayca; Tufek, Muhammed Taha
    Background: Flat feet change lower-extremity alignment, and they may change the load distribution on the Achilles tendon during exercise. The purpose of this study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet. Methods: Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at three points: 1, 2, and 3 cm proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises, which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion. Results: Achilles tendon thickness at all three points measured was thinner in the flat feet group at preexercise and postexercise conditions compared with that of the control group (P < .05). Achilles tendon thickness at all three points decreased after the exercise in both groups (P < .001). The differences in Achilles tendon thickness at all three points measured between preexercise and postexercise conditions were lower in individuals with flat feet than in those of the control group (P < .05). Conclusions: There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, tendon thickness markedly diminished in individuals with normal foot posture. The findings are thought to result from changes in tendon structure and load distribution on the Achilles tendon.
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    Pulmonary Functions in Patients With Chronic Neck Pain: A Case-Control Study
    (Mosby-Elsevier, 2022) Dag, Figen; Tas, Serkan; Cimen, Ozlem Bolgen
    Objective: The purpose of the study was to investigate pulmonary functions of patients with chronic neck pain and compare them with those of asymptomatic controls.Methods: This case-control study was conducted with 25 patients with chronic neck pain (age, 26.84 +/- 7.89 years) and 27 age-matched asymptomatic controls (age, 25.96 +/- 7.13 years). Pulmonary function tests were performed using spirometry (Quark PFT, COSMED, Rome, Italy). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% vital capacity, peak expiratory flow, maximum voluntary ventilation, and the FEV1/FVC ratio were measured and are expressed as (%) predicted value for patients with chronic neck pain and asymptomatic controls. Results: The chronic neck pain group had lower FEV1 (P = .015), FVC (P = .029), forced expiratory flow at 25% to 75% vital capacity (P = .040), and maximum voluntary ventilation (P = .042) compared with asymptomatic controls; however, FEV1/FVC (P = .470) and peak expiratory flow (P = .183) were similar in both groups.Conclusion: These results demonstrated that dynamic lung volumes were lower in patients with chronic neck pain compared with asymptomatic controls. (J Manipulative Physiol Ther 2022;45;290-297)
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    YouTube videos as an information source about exercises for temporomandibular disorders
    (Wroclaw Medical Univ, 2024) Tok, Ozlem Nur; Yurttas, Ayse Nihal; Tas, Serkan
    Background. Temporomandibular disorders (TMD) are musculoskeletal and/or neuromuscular conditions that affect the muscles, joints and associated structures of the stomatognathic system. Objectives. This study aimed to evaluate the quality and reliability of publicly available English-language videos on YouTube about TMD exercises, and to examine the video sources and professional groups responsible for the creation of the videos. Material and methods. The quality and reliability of the YouTube videos related to TMD exercises were evaluated using the DISCERN score, the global quality scale (GQS) and the JAMA (Journal of the American Medical Association) score. Results. Of the 121 videos evaluated, 30 (24.8%) were uploaded by professional organizations, 49 (40.5%) by health information websites, and 42 (34.7%) were uploaded by independent users. Professional organizations had a significantly higher number of subscribers, likes, comments, and views than healthcare webpages and independent users (p < 0.001). The duration of videos uploaded by independent users was significantly longer than that of videos uploaded by healthcare webpages (p = 0.018). With regard to the profession of the video narrators, the unspecified group exhibited significantly lower JAMA (p < 0.001), GQS (p = 0.011) and DISCERN scores (p = 0.002) compared to chiropractors, physiotherapists, physicians, and other healthcare professionals. The JAMA scores for physicians, personal trainers and chiropractors were significantly lower than those for other healthcare professionals (p < 001). The JAMA score was positively correlated with the GQS (r = 0.469, p < 0.001) and DISCERN (r = 0.505, p < 0.001) scores. Similarly, the DISCERN score was positively correlated with the GQS score (r = 0.924, p < 0.001). Conclusions. Despite the abundance of video content on YouTube about TMD exercises, the quality of these videos is low, and their reliability is questionable.